<div class="tlr-assessment-container">
    <form class="form-horizontal">
        <div class="form-group">
            <div class="col-sm-12" style="border-bottom: 1px solid #BEBEBE; padding-bottom: 10px; font-size: 20px;">
                <label class="col-sm-3 control-label">10.预先护理计划</label>
            </div>
        </div>
        <div class="col-sm-12">
            <div class="form-group">
                <label for="exampleInputEmail1">通常指为将来制定计划以便将来具体措施安排的落实。您是否愿意完成下列信息</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_1" id="optionsRadios1" value="1"  ng-model="assessment.advancedCarePlan.comfortabletocomplete">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_1" id="optionsRadios2" value="0"  ng-model="assessment.advancedCarePlan.comfortabletocomplete">否
                    </label>
                </div>
            </div>

            <div class="form-group">
                <label for="exampleInputEmail1">您是否预先决定拒绝治疗</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_2" id="optionsRadios1" value="1"  ng-model="assessment.advancedCarePlan.refusetreatment">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_2" id="optionsRadios2" value="0"  ng-model="assessment.advancedCarePlan.refusetreatment">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">您是否已有一份意愿和偏好陈述对下列内容有详细说明</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_3" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.havewishe">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_3" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.havewishe">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">如果您的健康情况恶化，您希望在哪里接受护理和治疗（如在家、医院、安养院）</label>
                <input type="text" class="form-control input-sm tlr-table-editbox"  ng-model="assessment.advancedCarePlan.where">           
            </div>          

            <div class="form-group">
                <label for="exampleInputEmail1">您是否已经拟定医嘱并指定执行人</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_4" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.declarewill">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_4" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.declarewill">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">相关文件和资料是否都按时更新且方便查询</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_5" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.easytolocate">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_5" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.easytolocate">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">您是否制定过持久授权书，帮助您就房产事宜或个人福利问题进行决策</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_6" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.haveattorney">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_6" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.haveattorney">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">您是否已安排好去世后葬礼事宜，保证您的个人意愿和偏好，如土葬、火化、葬礼服务和礼乐及讣闻，受到尊重和落实 </label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_7" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.funeralplan">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_7" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.funeralplan">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                <label for="exampleInputEmail1">相关地方主管机构都会出台一份覆盖上述全部事宜的预先护理计划文件。您是够考虑填写这一文件</label>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_8" id="optionsRadios1" value="1" ng-model="assessment.advancedCarePlan.consideradocument">是
                    </label>
                </div>
                <div class="radio">
                    <label>
                        <input type="radio" name="optionsRadios10_8" id="optionsRadios2" value="0" ng-model="assessment.advancedCarePlan.consideradocument">否
                    </label>
                </div>
            </div> 
            <div class="form-group">
                    <label for="exampleInputEmail1" style="font-size: 16px;">预先护理计划  记录</label>
                    <textarea class="form-control" rows="5" ng-model="assessment.advancedCarePlan.notes"></textarea>
                </div>
            <div class="form-group">
                <div class="col-sm-9">
                    <input class="btn btn-default" style="float: right;" type="button" value="下一页" ng-click="nextPage(11)">
                    <input class="btn btn-default" style="float: right; margin-right: 30px;" type="button" value="上一页" ng-click="prevPage(9)">
                </div>
            </div>
        </div>
    </form>
</div>